Analysis of the diagnostic accuracy of Belin/Ambrósio Enhanced Ectasia and Corvis ST parameters for subclinical keratoconus.

OBJECTIVE: To investigate the diagnostic accuracy of the parameters in the Belin/Ambrósio Enhanced Ectasia Display built in Pentacam, which is designed for the screening of subclinical keratoconus (SKC) built in Pentacam, and the parameters in Corneal visualization Scheimpflug technology (Corvis ST). METHODS: A retrospective study: The fellow eyes of unilateral keratoconus cases were diagnosed with SKC. Patients presented to Shanxi Eye Hospital with SKC from October 2020 to November 2021 were included as the SKC group, and myopic patients undergoing corneal refractive surgery at the Refractive Surgery Department in our hospital within the same period were included as the control group. The Belin/Ambrósio and Corvis ST parameters were extracted from the system and analyzed using independent samples t test. Receiver operating curves (ROCs) were also created to test the diagnostic accuracy of each parameter. RESULTS: There were 70 patients (70 eyes) in the SKC group and 137 patients (137 eyes) in the control group. For Corvis ST parameters, Radius (P = 0.021), PachySlope (P = 0.040), SP-A1 (P = 0.002), A2 Deformation Amp. (P = 0.028), A2 Deflection Length (P < 0.001), Max ICR (P = 0.005), DA Ratio Max (1 mm) (P = 0.023), IR (P = 0.016), CBI (P = 0.003) and TBI (P < 0.001) were statistically different between the two groups. For Belin/Ambrósio parameters, PPI min. Axis, ART min, ART max, ART avg, Pachy min, Front K2, Astig, BAD-Df, BAD-Db, BAD-Dp, BAD-Dt, BAD-Da, BAD-D, PPI min, PPI max, PPI max. Axis, PPI avg and Dist.Apex-Thin.Loc. were significantly different between the two groups (all p < 0.001). TBI and BAD-D showed the best diagnostic accuracy, with AUCs of 0.944 and 0.965, respectively. CONCLUSIONS: Some Belin/Ambrósio and Corvis ST parameters differed between SKC eyes and eyes with normal cornea. TBI and BAD-D showed the ideal diagnostic performance for SKC. In clinical practice, conventional corneal topography could not be replaced by Corvis ST.

Antimicrobial resistance and genetic characterization of Shigella spp. in Shanxi Province, China, during 2006-2016.

BACKGROUND: Shigella spp., facultative anaerobic bacilli of the family Enterobacteriaceae, are one of the most common causes of diarrheal diseases in human worldwide which have become a significant public health burden. So, we aimed to analyze the antimicrobial phenotypes and to elucidate the molecular mechanisms underlying resistance to cephalosporins and fluoroquinolones in Shigella isolates from patients with diarrhea in Shanxi Province. RESULTS: During 2006-2016, we isolated a total of 474 Shigella strains (including 337 S. flexneri and 137 S. sonnei). The isolates showed high rates of resistance to traditional antimicrobials, and 26, 18.1 and 3.0% of them exhibited resistance to cephalosporins, fluoroquinolones and co-resistance to cephalosporins and fluoroquinolones, respectively. Notably, 91.1% of these isolates, including 22 isolates that showed an ACTSuT profile, exhibited multidrug resistance (MDR). The resistance rates to cephalosporins in S. sonnei isolates were higher than those in S. flexneri. Conversely, the resistance rates to fluoroquinolones were considerably higher in S. flexneri isolates. Among the 123 cephalosporins-resistant isolates, the most common extended-spectrum beta-lactamase gene was blaTEM-1, followed by blaCTX-M, blaOXA-1, and blaSHV-12. Six subtypes of blaCTX-M were identified, blaCTX-M-14 (n = 36) and blaCTX-M-55 (n = 26) were found to be dominant. Of all the 86 isolates with resistance to fluoroquinolones and having at least one mutation (Ser83Leu, His211Tyr, or Asp87Gly) in the the quinolone resistance-determining regions of gyrA, 79 also had mutation of parC (Ser80Ile), whereas 7 contained plasmid-mediated quinolone resistance genes including qnrA, qnrB, qnrS, and aac(60)-Ib-cr. Furthermore, pulsed-field gel electrophoresis analysis (PFGE) showed a considerable genetic diversity in S. flexneri isolates. However, the S. sonnei isolates had a high genetic similarity. CONCLUSIONS: Coexistence of diverse resistance genes causing the emergence and transmission of MDR might render the treatment of shigellosis difficult. Therefore, continuous surveillance might be needed to understand the actual disease burden and provide guidance for shigellosis.

Transferable Plasmid-Borne mcr-1 in a Colistin-Resistant Shigella flexneri Isolate.

Since the initial discovery of mcr-1 in an Escherichia coli isolate from China, the gene has also been detected in Klebsiella pneumoniae and Salmonella enterica but is rarely reported in other Enterobacteriaceae Here, we report the isolation and identification of a Shigella flexneri strain harboring mcr-1 from stool samples in a pig farm in China from 2009. The MIC of colistin for the isolate is 4 µg/ml. Conjugation assays showed that the donor S. flexneri strain has functional and transferable colistin resistance. Sequencing revealed that mcr-1 was present on a putative composite transposon flanked by inverted repeats of ISApl1IMPORTANCE There are four species of Shigella, and Shigella flexneri is the most frequently isolated species in low- and middle-income countries (LMICs). In this study, we report a functional, transferable, plasmid-mediated mcr-1 gene in S. flexneri We have shown that mcr-1 is located on a novel composite transposon which is flanked by inverted repeats of ISApl1 The host strain is multidrug resistant, and this multidrug resistance is also transferable. The finding of a functional mcr-1 gene in S. flexneri, a human-associated Enterobacteriaceae family member, is a cause for concern as infections due to S. flexneri are the main Shigella infections in most low- and middle-income countries.

Antibiotic resistance and molecular characterization of the hydrogen sulfide-negative phenotype among diverse Salmonella serovars in China.

BACKGROUND: Among 2179 Salmonella isolates obtained during national surveillance for salmonellosis in China from 2005 to 2013, we identified 46 non-H2S-producing strains originating from different sources. METHODS: The isolates were characterized in terms of antibiotic resistance and genetic variability by pulsed-field gel electrophoresis and multilocus sequence typing. Mutation in the phs operon, which may account for the non-H2S-producing phenotype of the isolated Salmonella strains, was performed in this study. RESULTS: Among isolated non-H2S-producing Salmonella strains, more than 50% were recovered from diarrhea patients, of which H2S-negative S. Gallinarum, S. Typhimurium, S. Choleraesuis and S. Paratyphi A isolates constituted 76%. H2S-negative isolates exhibited a high rate of resistance to ticarcillin, ampicillin, and tetracycline, and eight of them had the multidrug resistance phenotype. Most H2S-negative Salmonella isolates had similar pulsed-field gel electrophoresis profiles and the same sequence type as H2S-positive strains, indicating a close origin, but carried mutations in the phsA gene, which may account for the non-H2S-producing phenotype. CONCLUSIONS: Our data indicate that multiple H2S-negative strains have emerged and persist in China, emphasizing the necessity to implement efficient surveillance measures for controlling dissemination of these atypical Salmonella strains.

A Waterborne Outbreak of Shigella sonnei with Resistance to Azithromycin and Third-Generation Cephalosporins in China in 2015.

Here, we report for the first time a waterborne outbreak of Shigella sonnei in China in 2015. Eleven multidrug-resistant (MDR) S. sonnei isolates were recovered, showing high resistance to azithromycin and third-generation cephalosporins in particular, due to an mph(A)- and blaCTX-M-14-harboring IncB/O/K/Z group transmissible plasmid of 104,285 kb in size. Our study highlights the potential prevalence of the MDR outbreak of S. sonnei in China and its further dissemination worldwide with the development of globalization.

Derivation and application of a parameter for denitrification rates in the Taihu Lake model based on an isotope-labeled denitrification experiment.

In recent years, the total nitrogen concentration in Taihu Lake has decreased significantly. Denitrification, as the main nitrogen removal process, is the key reason for the decrease. Here, the denitrification parameter values in the Environmental Fluid Dynamic Code (EFDC) model were calculated based on isotope-labeled denitrification experiment instead of selecting the recommended values directly. This study further focused on EFDC denitrification parameter derivation with an experimental denitrification rate (Dtot) to reduce simulation errors. According to the EFDC nitrate deposition flux mechanism, the conversion equation between the denitrification rate of the first sediment layer ([Formula: see text]) in EFDC and Dtot was successfully derived. The results revealed a linear correlation between [Formula: see text] and (Dtot)1/2. The [Formula: see text] values of sampling points ranged from 0.25 to 0.27 m·day-1, within the range of model parameters. After substituting [Formula: see text] into the Taihu Lake EFDC model, the average percentage bias and determination coefficient of total nitrogen were 16.25% and 0.87, respectively. The average total nitrogen concentration reduction caused by denitrification at water quality calibration points ranged from 0.027 to 0.305 mg·L-1.

Arrhenius equation construction and nitrate source identification of denitrification at the Lake Taihu sediment - water interface with 15 N isotope.

Total nitrogen in Taihu Lake, China has gradually decreased since 2015 while the total phosphorus concentration has exhibited an increasing trend, indicating an asynchronous change. The dominant nitrogen removal process in freshwater ecosystems is denitrification which primarily occurs at the sediment-water interface. In this study, 15 N isotope incubation experiments were attempted to analyze the effect of water temperature on denitrification, to construct the regional denitrification Arrhenius equations considering water temperature, and to identify the nitrate source of denitrification in Lake Taihu sediments. The results indicated that the potential N2 production rates and denitrification rates generally decreased in the west to east direction, which was significantly positively correlated with the nitrate concentration of overlying water by Pearson correlation coefficient analysis (P < 0.05). In addition, when the water temperature was lower than 30 °C, the rates of the potential N2 production and denitrification were higher with an increase in water temperature, but when the water temperature was overhigh, denitrification was inhibited. The ratio of the total denitrification rate of nitrate from the water column in the sediment to the total denitrification rate during the incubation experiment was above 0.5 at each sampling site. This indicated that the denitrification in the Lake Taihu sediment primarily occurred at the expense of nitrate from the water column. The research results of Arrhenius equation construction and nitrate source identification of denitization can be applied to improve the accuracy of water quality model of Taihu Lake, which is of great significance to improve Taihu Lake water quality, and can act as a reference for the water environment treatment of other shallow eutrophic lakes in China and abroad.

Sub-Bowman keratomileusis versus femtosecond laser in situ keratomileusis on the long-term visual recovery: A comparative study.

Purpose: To explore the long-term visual quality of the same subjects after sub-Bowman keratomileusis (SBK) or femtosecond laser in situ keratomileusis (FS-LASIK). Methods: This prospective study included patients screened for corneal refractive surgery at the Refractive Surgery Center of our Hospital between November 2017 and March 2018. One eye underwent SBK, while the other eye underwent FS-LASIK. Total higher-order aberrations, coma aberrations, and clover aberrations were evaluated before and at 1 month and 3 years after the procedure. The visual satisfaction of both eyes was investigated, respectively. The participants completed a surgical satisfaction questionnaire. Results: Thirty-three patients were included. There were no significant differences in total higher-order aberrations, coma aberrations, and clover aberrations between the two procedures before and 1 month and 3 years after surgery (all P > 0.05), except for the total coma aberrations in FS-LASIK were significantly higher compared with the SBK group at 1 month after surgery [0.51 (0.18, 0.93) vs. 0.77 (0.40, 1.22), P = 0.019]. The surgical satisfaction questionnaire scores of the SBK group and the FS-LASIK group were 9.8 ± 0.8 and 9.8 ± 0.8, respectively, at 1 month, and 9.7 ± 0.9 and 9.7 ± 1.0, respectively, at 3 years (all P > 0.05). Conclusion: There were no differences in corneal aberrations and satisfaction between SBK and FS-LASIK procedures at 1 month and 3 years.

Enabling a high-performance saltwater Al-air battery via ultrasonically driven electrolyte flow.

As an emerging battery technology, the Al-air flow battery (AAFB) exhibits high energy density due to the recycling of electrolytes, thus showing great potential as a type of clean and sustainable energy storage system. Conventionally, it employs an external mechanical pump to recycle the electrolyte. In this work, the saltwater AAFB in which the electrolyte is recycled by the ultrasonic capillary effect (rather than a mechanical pump) and the reaction chamber is agitated by ultrasonic vibration, is proposed and investigated. Our numerical simulations show that a travelling ultrasonic wave in the electrolyte flow system causes the capillary flow and agitation. The experimental results show that the percentage increase of the peak power density (relative to that with static electrolyte) can be up to about 7.5 times of that with the electrolyte flow driven by a mechanical pump, under the same electrolyte flow rate and concentration (3.3 ml min-1 and 3 M NaCl). The optimal peak power density, which can be achieved by optimizing the reaction chamber thickness, electrolyte concentration and ultrasonic vibration velocity, is 43.88 mW cm-2. This work illustrates that the acoustofluidic method can not only improve the discharge performance of the saltwater AAFB effectively, but also greatly decrease the energy consumption, weight and volume of the electrolyte driving unit of the AAFB. In addition, analyses based on experimental results show that the energy gain of a series/parallel battery system formed by multiple identical cells can be larger than one, if the number of cells in the system is large enough.

Acoustofluidic black holes for multifunctional in-droplet particle manipulation.

Acoustic black holes offer superior capabilities for slowing down and trapping acoustic waves for various applications such as metastructures, energy harvesting, and vibration and noise control. However, no studies have considered the linear and nonlinear effects of acoustic black holes on micro/nanoparticles in fluids. This study presents acoustofluidic black holes (AFBHs) that leverage controlled interactions between AFBH-trapped acoustic wave energy and particles in droplets to enable versatile particle manipulation functionalities, such as translation, concentration, and patterning of particles. We investigated the AFBH-enabled wave energy trapping and wavelength shrinking effects, as well as the trapped wave energy-induced acoustic radiation forces on particles and acoustic streaming in droplets. This study not only fills the gap between the emerging fields of acoustofluidics and acoustic black holes but also leads to a class of AFBH-based in-droplet particle manipulation toolsets with great potential for many applications, such as biosensing, point-of-care testing, and drug screening.

Design and preparation of three-dimensional hetero-electrocatalysts of NiCo-layered double hydroxide nanosheets incorporated with silver nanoclusters for enhanced oxygen evolution reactions.

Layered double hydroxides (LDHs) are one of the most effective electrocatalysts. However, it is still necessary to improve the lower conductivity and limited active sites of LDHs to enhance their catalytic performance. Targeted generation of vacancies on the catalyst's surface by the incorporation of metal nanoparticles has been explored as a promising strategy to synthesize highly efficient electrocatalysts. Herein, we designed and prepared novel three-dimensional (3D) hetero-electrocatalysts of NiCo-layered double hydroxide nanosheets incorporated with silver nanoclusters on a Ni foam (labeled as Ag@NiCo-LDH/NF) by a one-pot hydrothermal method. We also conducted experimental and theoretical investigations to demonstrate the high electrocatalytic performance of the Ag@NiCo-LDH/NF hetero-electrocatalysts for OERs and the underlying mechanism. The resulting hetero-electrocatalysts show a low overpotential of 262 mV at a current density of 10 mA cm-2, and even exhibit low overpotentials of 300 mV at a high current density of 50 mA cm-2 and 324 mV at 100 mA cm-2, and a small Tafel slope of 41 mV dec-1 as well as excellent durability for 80 h for OERs in 1.0 M KOH. The excellent performance is attributed to the synergistic effects between Ag nanoclusters and LDHs. The population engineering effect of silver not only helps to modulate the intrinsic properties of active sites but also induces the generation of abundant oxygen vacancies on the surface; finally, it facilitates the rate-determining step of OERs (ΔG3 (O* → OOH*) = 1.31 eV) to gain high performance. The one-pot silver incorporating strategy and the resulting high performance pave new ways for the further development of highly efficient electrocatalysts for OERs.

The correlational study about neutrophil-to-lymphocyte ratio and exercise tolerance of chronic obstructive pulmonary disease patients.

To study the relationship between neutrophil to lymphocyte ratio (NLR) and exercise tolerance of patients with chronic obstructive pulmonary disease (COPD).235 patients with COPD were selected as the study subjects. Complete blood count, C reactive protein (CRP), pulmonary function tests, the 6-minute walk distance (6MWD), Modified Medical Respiratory Council, the COPD assessment test, and clinical COPD questionnaire were tested. Heart rate, oxygen saturation, and Borg scale were tested before or after 6MWD test.By the median of NLR, the subjects were divided into 2 groups, NLR ≥4.5 group and NLR <4.5 group. The white blood cell count (WBC), CRP and deoxygenation saturation in the NLR ≥4.5 group were higher than those in the NLR <4.5 group, while the age, body mass index (BMI), 6MWD, and heart rate variation were lower than those in the NLR <4.5 group. CRP, WBC, and deoxygenation saturation had positive effects on NLR, BMI, 6MWT, and heart rate variation had negative effects on NLR. The Pearson correlation analysis showed NLR was positively correlated with WBC, CRP, BMI index, 6MWT, and deoxygenation saturation, while it was negatively correlated with BMI and heart rate variation.NLR might associate with exercise tolerance and cardiorespiratory reserve of COPD patients, and could be used as an indicator of muscle function in COPD patients.

Multidrug-resistant Shigella sonnei carrying the plasmid-mediated mcr-1 gene in China.

Since the plasmid-mediated polymyxin resistance gene mcr-1 was first reported in Escherichia coli and Klebsiella pneumoniae in China, only one mcr-1-positive isolate of Shigella sonnei, containing inactivated mcr-1, has been reported worldwide. In this study, 1650 historical S. sonnei strains isolated from 2003-2015 in China were screened for the mcr-1 gene. Antimicrobial susceptibilities and resistance genes of mcr-1-positive isolates were determined, and the transferability of polymyxin resistance by plasmid conjugation was investigated. Pulsed-field gel electrophoresis (PFGE), plasmid profiles and Southern blotting were used to analyse genetic relationships and plasmid characteristics, and mcr-1-positive plasmids were sequenced. Six mcr-1-positive S. sonnei isolates from Shanghai (2010-2012) with polymyxin B resistance (MICs 4-8 µg/mL) were identified. Four of these exhibited multidrug resistance, including resistance to azithromycin and third-generation cephalosporins, and co-harboured blaCTX-M-14, mph(A) and blaTEM on different plasmids. mcr-1-positive plasmids shared highly similar IncI2 backbones that resembled reference plasmids, although some differences were observed, including various and abundant insertion sequences/patterns (IS1294, IS1 and ISApl1) and a diverse recombination shufflon region. mcr-1 in S. sonnei may date back to mid-2006. Here we report for the first time the presence of active mcr-1 in multidrug-resistant S. sonnei in China, which has existed since at least 2010. This study highlights the diverse mobile genetic elements on mcr-1-harboring plasmids, potentially resulting in high rates of mcr-1 horizontal transfer among Enterobacteriaceae. These findings emphasise the importance of continuous national and international surveillance of mcr-1-positive Shigella and changes in antibiotic resistance patterns.

An outbreak of acute respiratory disease caused by a virus associated RNA II gene mutation strain of human adenovirus 7 in China, 2015.

Human adenovirus 7 (HAdV-7) strains are a major cause of acute respiratory disease (ARD) among adults and children, associated with fatal pneumonia. An ARD outbreak caused by HAdV-7 that involved 739 college students was reported in this article. To better understand the underlying cause of this large-scale epidemic, virus strains were isolated from infected patients and sequence variations of the whole genome sequence were detected. Evolutionary trees and alignment results indicated that the major capsid protein genes hexon and fibre were strongly conserved among serotype 7 strains in China at that time. Instead, the HAdV-7 strains presented three thymine deletions in the virus associated RNA (VA RNA) II terminal region. We also found that the mutation might lead to increased mRNA expression of an adjacent gene, L1 52/55K, and thus promoted faster growth. These findings suggest that sequence variation of VA RNA II gene was a potential cause of such a severe HAdV-7 infection and this gene should be a new-emerging factor to be monitored for better understanding of HAdV-7 infection.

Antimicrobial Resistance of Salmonella enterica Serovar Typhimurium in Shanghai, China.

We aimed to analyze the antimicrobial resistance phenotypes and to elucidate the molecular mechanisms underlying resistance to cephalosporins, ciprofloxacin, and azithromycin in Salmonella enterica serovar Typhimurium isolates identified from patients with diarrhea in Shanghai. The isolates showed high rates of resistance to traditional antimicrobials, and 20.6, 12.7, and 5.5% of them exhibited decreased susceptibility to cephalosporins, ciprofloxacin, and azithromycin, respectively. Notably, 473 (84.6%) isolates exhibited multidrug resistance (MDR), including 161 (28.8%) isolates that showed an ACSSuT profile. Twenty-two MDR isolates concurrently exhibited decreased susceptibility to cephalosporins and ciprofloxacin, and six of them were co-resistant to azithromycin. Of all the 71 isolates with decreased susceptibility to ciprofloxacin, 65 showed at least one mutation (D87Y, D87N, or D87G) in gyrA, among which seven isolates simultaneously had mutations of parC (S80R) (n = 6) or parC (T57S/S80R) (n = 1), while 49 isolates with either zero or one mutation in gyrA contained plasmid-mediated quinolone resistance (PMQR) genes including qnrB, qnrS, and aac(6')-Ib-cr. Among the 115 cephalosporin-resistant isolates, the most common ESBL gene was blaCTX-M, followed by blaTEM-1, blaOXA-1, and blaSHV -12. Eight subtypes of blaCTX-M were identified and blaCTX-M-14 (n = 22) and blaCTX-M-55 (n = 31) were found to be dominant. To the best of our knowledge, this is the first report of the presence of blaCTX-M-123 and blaCTX-M-125 in S. Typhimurium. Besides, mphA gene was identified in 15 of the 31 azithromycin-resistant isolates. Among the 22 isolates with reduced susceptibility to cephalosporins and ciprofloxacin, 15 contained ESBL and PMQR genes. Coexistence of these genes lead to the emergence of MDR and the transmission of them will pose great difficulties in S. Typhimurium treatments. Therefore, surveillance for these MDR isolates should be enhanced.

Analysis of miRNAs Involved in Mouse Brain Damage upon Enterovirus 71 Infection.

Enterovirus 71 (EV71) infects the central nervous system (CNS) and causes brainstem encephalitis in children. MiRNAs have been found to play various functions in EV71 infection in human cell lines. To identify potential miRNAs involved in the inflammatory injury in CNS, our study, for the first time, performed a miRNA microarray assay in vivo using EV71 infected mice brains. Twenty differentially expressed miRNAs were identified (four up- and 16 down-regulated) and confirmed by qRT-PCR. The target genes of these miRNAs were analyzed using KEGG (Kyoto Encyclopedia of Genes and Genomes) analysis, revealing that the miRNAs were mainly involved in the regulation of inflammation and neural system function. MiR-150-5p, -3082-5p, -3473a, -468-3p, -669n, -721, -709, and -5107-5p that regulate MAPK and chemokine signaling were all down-regulated, which might result in increased cytokine production. In addition, miR-3473a could also regulate focal adhesion and leukocyte trans-endothelial migration, suggesting a role in virus-induced blood-brain barrier disruption. The miRNAs and pathways identified in this study could help to understand the intricate interactions between EV71 and the brain injury, offering new insight for the future research of the molecular mechanism of EV71 induced brainstem encephalitis.

Diversity of New Delhi metallo-beta-lactamase-producing bacteria in China.

OBJECTIVES: The prevalence and dissemination of diverse NDM-producing bacteria in China was investigated. METHODS: We collected 1,162 isolates from 8 cities during December 2013∼May 2015 in China. The NDM-positive strains as well as the NDM genotypes in these sample were detected via Vitek 2 compact system (bioMérieux, France), 16S rRNA gene sequencing, PCR and an S1- pulsed-field gel electrophoresis assay and Southern blot hybridization. The horizontal-transfer capability of the blaNDM gene was assessed by filter mating by using a standard E.coli J53 azide-resistant strain as the recipient. RESULTS: Three genotypes (NDM-1, NDM-3 and NDM-5) of NDM-producing bacteria were identified, among which the NDM-1-positive isolates were the most frequent one. For the first time, we found NDM-5-produing S.typhimurium and NDM-3-produing E.coli in China. We also found that the NDM-positive (especially NDM-3 and NDM-5) strains were completely resistant to nearly all of the antimicrobial drugs utilized and blaNDM was mostly located on diverse plasmids with sizes ranging from 30 to 670kb. CONCLUSION: Various species of bacteria especially the enteric pathogens with diverse NDM genotypes had spread in China. Hence, an ongoing surveillance of their dissemination is essential to prevent and control the spread of these organisms.

Molecular Characterization of Salmonella enterica Serovar Aberdeen Negative for H2S Production in China.

Salmonella enterica infections continue to be a significant burden on public health worldwide. The ability of S. enterica to produce hydrogen sulfide (H2S) is an important phenotypic characteristic used to screen and identify Salmonella with selective medium; however, H2S-negative Salmonella have recently emerged. In this study, the H2S phenotype of Salmonella isolates was confirmed, and the selected isolates were subjected to antimicrobial susceptibility testing and molecular identification by multilocus sequence typing, pulsed-field gel electrophoresis, and clustered regularly interspaced short palindromic repeat (CRISPR) analysis. The phs genetic operon was also analyzed. A total of 160 S. enterica serovar Aberdeen isolates were detected between 2005 and 2013 in China. Of them, seven non-H2S-producing isolates were detected. Notably, four samples yielded four pairs of isolates with different H2S phenotypes, simultaneously. The data demonstrated that H2S-negative isolates were genetically closely related to H2S-positive isolates. Three new spacers (Abe1, Abe2, and Abe3) were identified in CRISPR locus 1 in four pairs of isolates with different H2S phenotypes from the same samples. Sequence analysis revealed a new nonsense mutation at position 208 in the phsA gene of all non-H2S-producing isolates. Additionally, we describe a new screening procedure to avoid H2S-negative Salmonella, which would normally be overlooked during laboratory and hospital screening. The prevalence of this pathogen may be underestimated; therefore, it is important to focus on improving surveillance of this organism to control its spread.

Molecular characterization and analysis of high-level multidrug-resistance of Shigella flexneri serotype 4s strains from China.

To conduct the first comprehensive analysis of Shigella flexneri serotype 4s, a novel serotype found in 2010, we identified 24 serotype 4s isolates from 1973 shigellosis cases in China (2002-2014). The isolates were characterized by single nucleotide polymorphism (SNP) phylogenetic analysis, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST) to determine their genetic relatedness, and analysed further for their antimicrobial susceptibilities and antimicrobial resistance determinants. The PFGE and SNP phylogenetic analyses suggest that S. flexneri serotype 4s strains are derived from multiple serotypes, including two predominant serotypes in China: serotype X variant and serotype II. Three new sequence types were identified by MLST. All isolates were resistant to ticarcillin, ampicillin and tetracycline, with high-level resistance to third-generation cephalosporins. Notably, all the isolates were multidrug resistant (MDR), with the highest levels of resistance observed for eight antimicrobials classes. Most isolates contain various antimicrobial resistance determinants. In conclusion, we found that serotype 4s isolates have multiple evolutionary sources, diverse biochemical characteristics and genomes, and highly prevalent multidrug resistance and antimicrobial-resistant determinants. With few clinical treatment options, continuous monitoring and timely intervention against this emerging MDR serotype is essential. The possibility that serotype 4s will become the next predominant serotype exists.

Emergence of ONPG-negative Shigella sonnei in Shanghai, China.

Shigella sonnei has become predominant species causing shigellosis in Shanghai. Two hundred ninety-three S. sonnei were isolated in sentinel hospitals of Shanghai in 2011. We found an emergence of 8 strains of S. sonnei with negative phenotype for o-nitrophenyl-ß-d-galactopyranoside in late August, which showed distinct pulsed-field gel electrophoresis patterns from the other 285 S. sonnei and had genes deletion in lac and mhp operons.